Note: The job is a remote job and is open to candidates in USA. The Wilshire Group is a boutique healthcare consulting firm specializing in revenue cycle optimization and collaboration between operational and IT teams. The Revenue Integrity Consultant will support client engagements involving revenue integrity, chargemaster management, charging, compliance, optimization, implementations, and post-live stabilization. The role is client-facing and requires collaboration with operational, clinical, financial, and IT stakeholders to improve financial performance and billing accuracy.
Responsibilities
- Partner with client teams to assess current revenue integrity processes and identify opportunities for improvement
- Provide comprehensive Chargemaster (CDM) expertise across both Hospital Billing (HB) and Professional Billing (PB). CDM Consolidation experience for a new install or an Epic Refuel is a requirement for this role
- Review CDM structure, maintenance, and processes to identify revenue leakage, charging issues, and opportunities for improved charge capture
- Evaluate and align revenue codes with appropriate hard-coded and soft-coded charging requirements
- Analyze charging workflows and provide strategic recommendations to improve revenue integrity and compliance
- Identify and support optimization opportunities related to CDM management, maintenance, and integration with clinical and financial Epic modules
- Apply revenue integrity best practices to support charge capture, billing accuracy, and denial prevention
- Review revenue cycle processes for compliance with hospital billing requirements and identify potential audit risks
- Support revenue integrity assessments, implementations, optimization projects, and post-live stabilization activities
- Collaborate with operational, clinical, financial, and IT stakeholders to develop practical solutions
- Communicate findings, recommendations, and project status clearly to client leadership and project teams
- Adapt to varying client needs and provide support across multiple areas of a project when needed
- Contribute to the continued growth and success of The Wilshire Group through knowledge sharing, collaboration, and professional development
Skills
- 10+ years of revenue integrity experience within a hospital or health system environment
- Strong knowledge of Epic Hospital Billing (HB) (this role focuses on HB) and Professional Billing (PB) functionality, particularly related to charging and charge capture
- Comprehensive knowledge of Chargemaster management and revenue integrity operations
- Working knowledge of CPT coding and its application within revenue integrity operations
- Experience identifying and addressing charging, billing, and revenue leakage opportunities
- Knowledge of hospital billing compliance, audits, and denial prevention strategies
- Experience supporting Epic implementations, optimization, or post-live initiatives
- Strong analytical, problem-solving, and consulting skills
- Excellent written and verbal communication skills with the ability to work effectively with client stakeholders at multiple levels
- Ability to work independently, manage competing priorities, and adapt to changing client needs
- Bachelor's degree or equivalent combination of education and relevant experience
- Epic certification preferred/required based on project needs. Not required for this role – the experience working on the operational side is more important
- For those local to Texas, this job could become contract-to-hire if that is something you are interested in. It would require two weeks onsite in Houston at the beginning of the project, and at least one day a week onsite in Houston for the length of the project. The rest of the days would be remote
- For someone with a higher level of experience, fully remote candidates (with 1-3 trips to Houston over the course of the project – lasting a year) will be considered
Benefits
- Remote work arrangement
- For those local to Texas, this job could become contract-to-hire if that is something you are interested in.
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